Mental Hospitals – One Of The Most Dangerous Work Environments In The United States

By Gary E. Adams

A recent article in the New York Times brought to light an issue that workers in mental hospitals have known for years- that they work in one of the most dangerous work environments in the United States.

The author, who works in a mental hospital, observes that “patients, even violent ones, are often given a shocking amount of freedom. As a consequence, every day, across the country, these hospitals record dozens of assaults by patients against staff members and other patients — a situation that, thanks to expanded patients’ rights laws and state health bureaucracies, we can do almost nothing about”.

As a result, thousands of employees of mental health facilities are assaulted every year across the country, with little or no recourse against those who assaulted them.

The author points out that “state hospitals are ill-prepared to deal with these often dangerous and violent persons. A large part of the problem stems from our legal system, where the notion of patients’ rights has triumphed over common sense and safety. For example, despite criminally insane patients being remanded by the courts for psychiatric treatment, many states allow them to refuse both therapy and medication.

A second difficulty is bad hospital policy: At many state forensic facilities, there are no guards, and untreated psychotic patients are allowed to mix freely with the staff. Perhaps because the extent of violence in forensic hospitals is difficult to imagine, it’s easier for hospital administrations, elected state officials and governors to ignore.

Still harder to explain is the silence of mental health activist and regulatory groups — the American Civil Liberties Union, the Occupational Safety and Health Administration and the National Alliance on Mental Illness. Generally at the forefront of worker and patient safety issues, these organizations have inexplicably done very little.

There are a few obvious responses. Judges can require that patients accept therapy and medication. Hospitals should have trained guards, and should be required to build intensive treatment units to house the 15 percent of patients responsible for the majority of the violence. These units would separate the patients from the rest of the population, and from each other. Hospitals should also create opportunities for more family involvement in the patients’ care — a proven factor in reducing violent behavior.

These hospitals are meant to be places where mentally ill people go to get better. Instead, as one patient at PattonStateHospital in California told The Los Angeles Times, “All day long it’s all about sorrow, sadness and hopelessness.”

Stephen Seager, the author of the New York Times article, is a psychiatrist at NapaStateHospital and the author of “Behind the Gates of Gomorrah: A Year With the Criminally Insane.”

In Mercer County, two facilities operated by the State of New Jersey house patients deemed to be either criminally insane or a danger to themselves or others- Trenton Psychiatric Hospital and the Ann Klein Forensic Center. In my 35 years of experience in representing workers at these facilities, I’ve heard these same problems described above hundreds of times. Violent patients injure other patients, nurses, aides and medical security officers on a regular basis. Even when attacked, the workers are extremely limited in the manner in which they can defend themselves, even if their lives are in danger. Termination can result if the worker is deemed to have defended him or herself too aggressively. Understaffing, especially among security personnel, seems to be the norm.

For those who work in these facilities and sustain injuries, their only legal recourse in most situations is to file a claim under New Jersey’s Workers’ Compensation Law. This statute provides them with a wage replacement while out of work recovering from their injuries, payment of medical expenses related to the injury, and a monetary award if a permanent injury is sustained.

Given the frequency of injuries at these institutions, it would seem prudent for the State to take steps to prevent these injuries by better controlling the violent patients who are responsible for causing them- but little seems to change.